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General NPI Number Information
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NPI Number | 1023654241
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Entity Type | Organization
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Legal Business Name | ELMER A. VILLALON, DMD, LLC
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Dates
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Enumeration Date | 11/22/2019
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Last Update Date | 11/22/2019
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Provider Practice Location Address
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Address Line | 1225 NORTH MAIN STREET #207
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City | PUEBLO
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State | CO
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Zip | 81003
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Country | US
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Telephone | 719-542-7844
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Fax | 719-542-7870
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Provider Business Mailing Address
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Address Line | 1225 N MAIN ST STE 207
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City | PUEBLO
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State | CO
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Zip | 81003-2857
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Country | US
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Telephone | 719-542-7844
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Fax | 719-542-7870
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELMER A. VILLALON
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Credential | DMD
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Telephone | 719-542-7844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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